St. George, Utah Zion Pain Management

Treatment of Herpes Zoster (Shingles) by Dr. Dale Stott

Acute herpes zoster, better known as shingles, is a very common disease that is often trivialized as merely a self-limiting skin rash. However, in reality shingles represents an extremely painful viral infection of the nervous system, which can evolve into a miserable chronic pain condition. In fact, the pain from this condition is so severe that it represents one of the leading causes of suicide among those over the age of seventy. Fortunately, today there are treatments available to help prevent this from occurring.

Shingles comes from humble beginnings. It results from the reactivation of the same virus that causes chickenpox, which can lie dormant for decades in the nervous system until the host’s immune system breaks down. Once reactivated, the virus makes its way back through the affected nerve to the skin where it manifests itself by a rash characterized by tiny blisters and spontaneous pain often described as burning, itching, and aching. The skin may become so tender and sensitive that even the weight of clothing is not tolerated. The virus may also attack the eyes and if untreated can lead to blindness.

The pain from this virus often precedes the rash by up to two weeks and is often confused in this pre-eruptive stage with other maladies such as angina, appendicitis, gallbladder problems, herniated disc, or neuromuscular disease. However, once the rash appears the diagnosis is usually fairly apparent.

In most cases, the lesions crust over in two to four weeks and the pain resolves with the disappearance of the rash. Unfortunately, severe intractable pain sometimes persists long after the rash has disappeared. This condition, known as post herpetic neuralgia (PHN), is very common in the elderly. In fact almost fifty percent of those over sixty years old who acquire shingles will develop PHN if they do not receive appropriate and prompt treatment.

Shingles occurs more commonly in the elderly population and in those whose immune systems are suppressed. There are about 300,000 cases in the United States per year. It is estimated that over a lifetime of eighty years about thirty percent of the population will acquire the disease at some stage. Unfortunately, the only way to prevent shingles is to prevent chickenpox, which for most people is not an option.

While there are now antiviral medications available to treat shingles, unfortunately they are somewhat limited in their effectiveness. For starters, they must be started very early in the course of the disease, usually in the first seventy-two hours, and they do not reliably prevent post herpetic neuralgia.

Currently, the most effective and reliable treatment for rapid pain relief in shingles and for prevention of PHN can be achieved through special nerve blocks performed by a qualified pain specialist. If done within the first three to four weeks of the outbreak of shingles these blocks can shorten the course of the disease, reduce or eliminate the pain, and greatly reduce the likelihood of PHN.

If PHN has already developed, there are still treatments available which can reduce its severity. These include nerve blocks, oral medication and topical patches.